Alcohol Harm

Baroness Blackwood of North Oxford Excerpts

Thursday 2nd February 2017 Westminster Hall

[Bill Esterson]

I am pleased that the hon. Lady reminded me of that piece of evidence. Perhaps we should tour the country as a double act, because this is turning into one: she can remind me of all the bits I forget.

The hon. Lady is right about how important this is. It is not just about individual tolerance; tolerance changes as women get older and as they have more children. In families in which, sadly, more than one child is affected by exposure to alcohol during pregnancy, it is invariably younger children who are damaged most.

We all know about the dangers of smoking—now, nobody would dream of saying anything other than, “Don’t smoke during pregnancy”—but we have not got to that point with alcohol. FASD was first diagnosed in 1973. It has been known about since then, so why has so little been done about it in this country? Much more has been done in other countries; they have approached FASD far more effectively. We had good progress from the chief medical officer, but we need so much more.

What do we need to do? We need to have a prevalence study to understand the situation in this country fully, including why women are still drinking during pregnancy. Some of it is about awareness, but there are some other findings from Sweden that I will draw to people’s attention. In a Swedish study, women mentioned societal factors such as peer pressure, not wanting others to suspect that they were pregnant, and insufficient education, as some thought that drinking small amounts during pregnancy was harmless, and we have just heard about the problems that causes. Personal factors were also important, for example not wanting to miss the enjoyment of alcohol. Those were reasons that women in Sweden gave to explain why they felt that abstinence from alcohol during pregnancy was so difficult for them. We must understand those factors in order to do something about them.

That is why it is so long overdue for the Government to go so much further than they have already. We need a prevalence study to understand whether the 35,000 figure that I have cited is correct, and to understand why women are drinking during pregnancy to the extent that they are. Then we can start to make progress in reducing the incidence of problems and providing the support that is needed, because the cost to those children who are affected by alcohol and their families is catastrophic, and it is hugely expensive for us as a society and economy. The situation cannot be allowed to continue.

I urge the Minister to act. I think this is the first time that she has been involved in a debate on this particular issue—

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

indicated assent.

[Bill Esterson]

This is a chance for the Minister to start on the right footing and to really make some progress.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I congratulate my hon. Friend the Member for Congleton (Fiona Bruce), the hon. Member for Sefton Central (Bill Esterson) and the right hon. Member for Birmingham, Hodge Hill (Liam Byrne) on securing this hugely important and deeply moving debate on tackling alcohol harm. I pay tribute to each of them for the work that they have done in leading their APPGs, raising awareness, holding the Government to account and developing policy. We have heard incredibly eloquent testimony from several Members about the harms that alcohol misuse can cause to individuals themselves, but just as much to their friends, family and children. We have also heard about the cost to wider society, and in particular to vital public services such as the NHS.

The majority of people who consume alcohol do so at low-risk levels and as a pleasurable part of their social lives. Pubs and restaurants play an important part in our communities, both as venues for gatherings and, as employers and businesses, as significant contributors to local economies. We should not forget that, but as we have heard, there are very serious harms associated with alcohol misuse that we must not forget either. I would like to take this opportunity to discuss those harms while noting that some progress has been made. I will outline some of the steps that the Government are taking to ensure that consumers have the information that they need to make good choices about their drinking, to equip frontline professionals with the training they need to intervene effectively and to invest in evidence-based services to help people cut back. Of course, that must all be underpinned by the right data and the expertise and advice of Public Health England.

My hon. Friend the Member for Congleton, who gave an outstanding opening speech, rightly pointed to the recent PHE evidence review, which tells us that alcohol is now the leading risk factor for ill health, early mortality and disability among 15 to 49-year-olds in England. It causes 169,000 years of working life to be lost, which is more than the 10 most common types of cancer combined. It is also a significant contributor to some 60 health conditions, including circulatory and digestive diseases, liver disease, several cancers and depression. As many colleagues have said, alcohol-related deaths have increased—particularly deaths due to liver disease, which rose by 400% between 1970 and 2008. That is in contrast with the trends in much of western Europe. More than 10 million people drink at levels that increase the risks to their health, and there are more than 1 million alcohol-related hospital admissions annually, half of which occur in the most deprived communities. It is important for us to face up to that as a nation.

As we have heard, the public health burden of alcohol, including its health, social and economic harms, is wide-ranging. There are direct and tangible costs to the health, criminal justice and welfare systems. According to PHE’s evidence review, the economic burden of alcohol is substantial; estimates place its annual cost at between 1.3% and 2.7% of GDP, and the estimated annual cost to the NHS is around £3.5 billion. Harms can also be indirect, including the loss of productivity due to absenteeism or unemployment, and they can be intangible and difficult to cost, such as the poor quality of life or emotional distress caused by living with a heavy drinker.

Much of that burden of disease and deaths is preventable, so it is right that the matter is given our full attention. Of particular interest to the Government is the strong inequalities profile of alcohol harms, which fall disproportionately on more deprived communities. We estimate that if all local authorities had a mortality rate that matched the most affluent areas, about 4,000 alcohol-related deaths would be avoided each year.

Though I note my hon. Friend’s calls for caution, there are some promising trends that give us cause for optimism. People under 18 are drinking less, attitudes are beginning to change and there has been a steady reduction in alcohol-related road traffic accidents. We have also seen real progress in Government working in partnership with industry. The industry removed 1.3 billion units of alcohol from the market through improving consumer choice of lower-alcohol products, and nearly 80% of bottles and cans now display unit content and pregnancy warnings on their labels.

As my hon. Friend the Member for Congleton—and my hon. Friend the Member for Ribble Valley (Mr Evans), who is no longer in his place—rightly said, partnership continues to play an important role in tackling alcohol misuse, and the Government are committed to that principle. In the report produced by the APPG that my hon. Friend the Member for Congleton, recommendation 9 is to educate the public about the harms of alcohol and do a better job in prevention. We are taking a number of actions to try to help people manage their alcohol consumption, because we believe that the most sustainable long-term solution to alcohol misuse is informed and empowered citizens and consumers. To ensure that that is possible, we have a responsibility to provide the most up-to-date and clear information to enable people to make informed choices about their drinking. That includes publishing the low-risk drinking guidelines, as we did last year, which a number of colleagues mentioned. Those guidelines provide the public with the latest information from the four UK chief medical officers about the health risks of different levels and patterns of drinking.

Officials are now working with partners in industry to update the advice provided on packaging and labelling to reflect the latest evidence. That is to ensure, as the hon. Member for Sefton Central mentioned, that awareness is raised and people understand exactly what those low-risk drinking guidelines mean.

[Fiona Bruce]

The Minister talks about increasing knowledge and awareness, but her Department’s own report says:

“Although playing an important role in increasing knowledge and awareness, there is little evidence to suggest that providing information, education…is sufficient to lead to substantial and lasting reductions in alcohol-related harm.”

I support that action, but, without the type of policies I addressed in my speech, I do not believe we will see the difference we need to make.

--- Later in debate ---

[Nicola Blackwood]

My hon. Friend is right that that is not enough in and of itself, but it was an important step, because we did need to review the latest evidence and provide updated risk guidelines. That is also why we remain committed to high-impact public education campaigns. Last year, PHE launched its “One You” campaign, which she may be aware of, which aims to motivate people to take steps to improve their health through action on the main risk factors, including alcohol consumption. “One You” has been used by more than 1.6 million people so far. It includes a drinks tracker app, which helps drinkers to identify risky behaviour and lower their alcohol consumption. PHE will launch a new “Days Off” app on 7 February to encourage people not to drink alcohol for a number of days a week, which is in line with the CMO’s guidelines. Evidence supports that as an effective way to reduce drinking and a good, effective and manageable way in which to use the guidelines.

[Bill Esterson]

I am pleased that the Minister is making practical suggestions to address some of the problems that have been raised. I hope that she will take up the shadow Health Secretary’s offer to work together on this. As an initial step, perhaps she could sit down individually with the three of us who initiated the debate to take things further, because we have said a lot today but there is a lot more to the debate that may be of assistance to her.

[Nicola Blackwood]

The hon. Gentleman put his finger on it when he said that a huge number of issues have been raised. I am trying to get through as many as I can. It is likely that I will not get through every point, so, if I do not, I will try to write. I will certainly try to give as much detail as I can. I think I noted everything down, but, if I did not, I am sure hon. Members will remind me with interventions. If they will let me make a bit of progress, I shall do my best.

In the report produced by my hon. Friend the Member for Congleton, recommendations 3 and 4 were to increase awareness and training for health professionals. A number of colleagues raised that as an important issue for identifying earlier and intervening on those who are misusing alcohol. We recognise that as important. All health professionals have a public health role, and we need to ensure that our frontline workforce are properly trained to tackle such challenges, especially alcohol misuse and drinking in pregnancy. I will come on to the points made by the hon. Member for Sefton Central in a minute.

[Kelvin Hopkins]

To be specific, will the Minister look carefully at what I suggested in my speech? We should have notices in all medical establishments and all areas where alcohol is consumed or purchased with the wording used in America about birth defects, and we should ensure that all medical professionals know about that problem and tell all women about it.

[Nicola Blackwood]

I will come in a moment to how we are dealing with the issues of foetal alcohol syndrome and foetal alcohol spectrum disorders, but I want to talk first about training for professionals, if that is okay.

By 2018, about 60,000 doctors will have been trained to recognise, assess and understand the management of alcohol use and its associated health and social problems. We think that is important so that future doctors can better advise on the health impact and effects of substance misuse. One of the key areas for that must be primary care. Since April 2015, the standard GP contract has included the delivery of an alcohol risk assessment to all patients registering with a new GP, which offers the opportunity to raise awareness of alcohol as a risk factor. In addition, the inclusion of an alcohol assessment in the NHS health check is a good opportunity for healthcare professionals to offer advice. That check is offered to all adults between 40 and 74 in England.

That large-scale intervention has the potential to make a real difference, because we know that one of every eight people who receive the intervention moderate their behaviour. Put simply, evidence shows that that is one of the most effective interventions available to us. Since we mandated the alcohol assessment and advice component in 2013, more than 10 million people have been offered a check, and nearly 5 million people have taken up the opportunity, which is a take-up rate of about 48%. That is progress, but we want to go further.

Recent research has shown that referrals to alcohol services following an NHS health check are about three times higher than among those receiving standard care. We therefore think that the health check is a good way to prompt an adjustment in behaviour. We will continue to deliver it, although we will be happy to hear recommendations on how we can improve it.

Another thing we are doing to support frontline professionals to identify those who might need more significant intervention is that Public Health England is currently leading a review of the higher-risk drinking advice. That is being undertaken in partnership with the devolved Administrations, and the updated advice will be published once the evidence has been considered.

The hon. Members for Sefton Central and for Luton North (Kelvin Hopkins) gave important speeches on the risks of FAS and FASD. They were concerned about the availability and understanding of the CMO’s guidelines. As I mentioned, we are working with partners in industry to update the advice provided on labels, which should disseminate those guidelines. I will certainly consider the comments made about putting that information on labels, in GP surgeries and in other appropriate locations. One of the other ways in which we are trying to get that information out is through the “One You” campaign and the drinks tracker, which I have just mentioned.

We are also trying to disseminate that information through health professionals in a more targeted way. Health professionals are supposed to discuss it with pregnant women as part of their routine work, but women who are heavy drinkers are much less likely to engage with antenatal care, so identifying them can be challenging. Over the past year, PHE has therefore been undertaking a piece of work to identify those at risk and provide advice. It has piloted in three regions of England a training programme developed in Wales called “Have a Word”, which sounds much like what the hon. Member for Sefton Central proposed. PHE is considering the findings from the pilots with a view to rolling the programme out across England if it is effective. We are particularly looking at the findings on how pregnant women can be targeted. I am happy to share those findings with the hon. Gentleman, as I suspect they will address his concerns on raising awareness and targeting pregnant women.

The hon. Gentleman raised the problem of professionals dismissing foetal alcohol spectrum, which sounds familiar. One problem I have been made aware of is the lack of research in this particular field and the need to increase it. Although the World Health Organisation has started a global prevalence study, which he called for, it recognises that information is lacking in many countries, including the United Kingdom. That creates a number of challenges, because the feasibility of estimating prevalence is difficult given the ethical challenges associated with research in that area.

Public Health England recently published the most comprehensive and up-to-date review of current harms of alcohols and the evidence on the effectiveness of alcohol control policies. We are currently engaged in further work to understand the impact of parental drinking on children; we discovered during the initial work that we did not have sufficient evidence on that, so we are going forward with that work. Public Health England is also developing prevalence figures at local authority level, as well a toolkit to support local authorities to respond to the issue of parental drinking. That is due to be published later next year, and I hope it will be of assistance to the right hon. Member for Birmingham, Hodge Hill in the work of his all-party parliamentary group as well.

One challenge we face is insufficient evidence, which is why we are trying to build the evidence base up so that we can assist medical professionals and local authorities as they try to make decisions; if they do not have the evidence, it is very difficult to make proper policy decisions in this area. I hope that reassures the hon. Member for Sefton Central, and I am happy to come back to him on any of the other points that he made.

We have also put several measures in place to ensure that children are provided with the information and tools they need, including through the Frank drug information and advice service. Family nurse partnerships help parents in vulnerable families to develop their parenting capacity, while tailored and co-ordinated support is offered via the troubled families programme. A lot of that needs to be delivered through local authorities; one of the recommendations in the report by my hon. Friend the Member for Congleton was to promote increased partnership through local communities. We believe it is right that local authorities should lead on that work as they are best placed to understand the different challenges in their areas; what is perhaps a challenge in Birmingham may be slightly differently represented in Bournemouth. However, we must make sure that local authorities are properly held to account when they lead on that, which is why we are keeping a close eye on whether they are delivering on these investments in the first place.

Our data show an increase in local authority spending on alcohol services for adults—from approximately £200 million in 2014-15 to £230 million in 2015-16—which we think demonstrates their understanding of the need for a commitment to invest in those treatment services. Our data also show that 85,000 individuals were treated in 2015, of whom 39% successfully completed treatment. The right hon. Member for Birmingham, Hodge Hill quoted different figures. I have not seen his freedom of information request or the response, so I am not sure why that is, but I am happy to investigate the variation between our figures and to discuss it with him to try to get to the bottom of exactly what is going on.

I am also happy to discuss the issues the right hon. Gentleman and the shadow Health Secretary raised regarding children of alcoholics; both made important and moving speeches about that. I thank the right hon. Gentleman for his leadership on this issue. I know it is not easy to speak out in this place about personal trauma and loss, and I know that we too often feel it will weaken us and expose us to personal attacks. I hope that by his standing up in that way, more people—not only in this building but across the country—will feel that they can be open about their personal experiences of addiction and of being in families with those with addiction, and will be able to seek help.

This is an incredibly important step in tackling addiction and the stigma that still exists around it. I thank both Members for the steps they have taken in progressing what is a very challenging cultural area in the UK, and I hope they will accept my commitment to working with them to trying to progress it as well. I want to put it on the record that we are trying to take steps, through the troubled families programme, to improve the situation for children of alcoholics. The troubled families programme has a responsibility to tackle problem drinking and to commission appropriate prevention and treatment services —including to support the children of those families.

[Liam Byrne]

I pay tribute to the Minister and welcome her commitment to working together across the aisle, so to speak, to put a new strategy in place. The troubled families programme is very important, not least because there is a lot of money in it. That money is often focused on families in the most chaotic of circumstances, but our evidence shows that many families with alcoholic parents do not look troubled or chaotic to the outside eye—they are often functioning alcoholics. Our definition of what constitutes a troubled family may therefore need to be stretched a little in order to help those children.

[Nicola Blackwood]

The right hon. Gentleman is obviously an expert on the issue, but understanding how to identify those at risk is not specific to this area of public health; it occurs in other areas and is familiar to me from my mental health brief as well. This will be something that we need to sit down and discuss to understand more accurately.

It may be that we need to look at the troubled families programme to see how that could be addressed in order to work more effectively to target those in need of assistance. The key message today is that children of alcoholics in the United Kingdom should not feel as though they are alone—they should feel as though support is there, and they should know that they will find help when they seek it. I must go on to talk about some of the other issues that were raised; I hope I am not taking too much time.

The NHS remains critical to the prevention of alcohol harms. We must incentivise NHS providers to invest in interventions to reduce risky behaviours and prevent ill health from alcohol consumption. NHS England and Public Health England have worked together to develop a national commissioning for quality and innovation—CQUIN—payments framework, which is an important intervention. For those less familiar with the CQUIN payments framework, it was set up to encourage service providers to continually improve the quality of care provided to patients. CQUIN payments enable commissioners to reward innovation by linking a proportion of service providers’ income to the achievement of national and local quality improvement goals. In this case, it means that every in-patient in community, mental health and acute hospitals will be asked about their alcohol consumption. Where appropriate, they will receive an evidence-based brief intervention or a referral to specialist services, which should improve the treatment of children in the care of alcoholics, as in cases like those raised by the shadow Health Secretary. That is something we should be pleased about.

More than 80% of hospitals offer some form of specialist alcohol service, and investment in similar alcohol care teams in every hospital would potentially provide the NHS with an opportunity to maximise its delivery of identification and brief advice interventions to patients. As I said, that has been identified as one of the most important interventions to change behaviours.

Hon. Members will be aware that the NHS and local authorities have been developing sustainability and transformation plans—STPs. Those are now published on NHS England’s website, and the vast majority include actions to reduce the harms from alcohol, including through investment in brief advice, which was one of the recommendations from my hon. Friend the Member for Congleton, and expanding the approaches for those with more problematic alcohol use. That is an encouraging sign. Underpinning all of our work is the expertise of Public Health England, as we have seen from its report. PHE staff work closely with local authorities and the NHS to try to tackle alcohol harms. Building on its recent review, we must ensure that it gives the right data analysis, so that local authorities know how to effectively target their policies.

One issue raised by a number of colleagues is the call for a review of the licensing legislation to include a health objective, as in Scotland. I have some questions about how effective that would be. Although it is easy to link a criminal justice problem to a specific location, it is much more difficult to link a health challenge to an individual establishment. It is quite hard to prove that buying a drink in an individual establishment has caused someone’s liver disease.

PHE is leading our engagement with the Home Office’s second phase of the local alcohol action areas programme and offering support and advice to participating areas that have identified improving the public health response to alcohol-related harms as a key focus of their approach. Successful applicants were announced by the Under-Secretary of State for the Home Department, my hon. Friend the Member for Truro and Falmouth (Sarah Newton), on 27 January, with 18 of the 33 successful areas looking at how they can improve the health of their residents. That is one way in which this is being done.

The House of Lords Select Committee on the Licensing Act 2003 is looking at that Act and is due to publish its report in March. We will, of course, carefully consider its recommendations. I gave evidence to the Committee, which is looking at health as part of that issue.

[Fiona Bruce]

On the issue of availability, the Minister’s Department’s own report indicates that reducing the number of hours during which alcohol is available and looking at density—the number of outlets where alcohol is sold—can help to reduce alcohol harm. I hope she will look at that as she proceeds. The local licensing objective could have real teeth if those issues were introduced into it.

[Nicola Blackwood]

My hon. Friend is passionate about this issue. I understand the argument for introducing the health objective. The problem is proving the risk posed by the individual establishment. However, we will consider the evidence that comes forward.

I will briefly turn to taxation, which was raised by a number of colleagues, including Scottish National party Members. I have to say at the outset that making changes to taxation is a matter for the Chancellor and slightly above my pay grade. We also have to note that the UK currently has the fourth highest duty on spirits compared with other EU member states, and higher strength beer and cider are already taxed more than equivalent lower strength products. We are considering the introduction of minimum unit pricing in England and Wales but are waiting for the outcome of the court case in Scotland. Until we hear the Supreme Court’s decision, which is still unknown—we are supporting the process of that case—we cannot proceed with any policy decision in the United Kingdom. It is a little unfair to berate us for not introducing a policy that cannot yet be enforced in Scotland.

On targeted changes in taxation, I am advised that current legislation on alcohol duties requires that duty on wines and ciders is paid at a flat rate within defined bands of alcoholic strength. I understand that my hon. Friends the Members for Congleton and for Ribble Valley have advice that it is possible to do something else, which I would be pleased to see, although that is a Treasury matter. At the moment, my understanding is that the EU directive sets bands for alcohol products in relation to strength and that while we have some flexibility to set rates within the structure of those bands, we are not able to link a duty absolutely to alcohol strength. Obviously, with our vote just yesterday, there is an opportunity with Brexit to consider these issues more specifically going forward, but that is my understanding of EU legislation as it stands and the advice I have received on this specific point.

[Fiona Bruce]

The information I have received is that the Government could just split the general rate into two separate brackets, therefore achieving their goal without the need to go through the EU. If the Minister will permit me, I will pass to her the opinion we have received on that.

[Nicola Blackwood]

My hon. Friend is very kind; I would be happy to see it.

I will close now, as I have cantered through a large number of issues and am sure hon. Members are tired of hearing my voice. I thank colleagues from both sides of the House for taking part. This has been an important debate. There have been very moving speeches, especially from the hon. Members for Sefton Central and for North Ayrshire and Arran (Patricia Gibson), the right hon. Member for Birmingham, Hodge Hill and the shadow Minister. They all illustrated powerfully the devastating impact that addiction and alcohol misuse have on not only people’s own health but, as we heard so eloquently, their families, children and local communities, not to mention the health and social care systems and wider society.

We have to give credit where it is due. We have to thank the many NHS workers, local authority staff, charities such as Childline and Aquarius and volunteers who are making such a difference in this area already. They are saving lives. We must recognise progress where it is being made, especially in the changing attitudes among young people. We must not despair.

However, as we have heard from today’s debate, stories and statistics, we cannot be satisfied with this. There is much more we can and must do, and I hope I have reassured colleagues today of my personal commitment to ensure we strengthen the information, support and, if necessary, treatment we give people to reduce the harms of alcohol misuse. With a health challenge as culturally entrenched as this, it can sometimes feel as though it is a mountain we will never successfully climb, but I take courage from today’s debate. Great social change requires three things: long-term political will, non-partisan partnership and bravery. I have heard all three of those today. I hope that each Member who has spoken here today will continue to work with me as we fight on to tackle this social injustice.

Breast Cancer Drugs

Baroness Blackwood of North Oxford Excerpts

Thursday 26th January 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

A large number of important and technical points have been raised today, and I will do my best to respond to as many of them as possible, but where I am unable to do so, I hope that colleagues will allow me to write to them. I congratulate the hon. Member for Mitcham and Morden (Siobhain McDonagh) on securing this important debate, and I join Members across the House in paying tribute to the all-party parliamentary group on breast cancer for all its advocacy on behalf of patients and families. The hon. Lady has campaigned tirelessly to improve access to breast cancer drugs on behalf of her constituents, and I share her commitment to ensuring that patients are able to benefit from the latest effective and often cutting-edge cancer drugs and technologies.

Cancer is a truly terrible disease, and as has been made clear by the many moving personal contributions that we have heard today, there are few of us who have not been touched by it. That is why the availability of effective drugs to treat cancer is of such importance to all of us and to so many of our constituents. I particularly want to thank all those who have allowed their personal stories to be shared today, and all who are here in the Public Gallery. These stories remind us powerfully of why we are all here, and their importance cannot be overestimated.

[Sir Desmond Swayne]

There is an all-party group for almost every disease known to man, with the possible exception of rigor mortis. If patients and campaigners are to have confidence in clinical decision makers, there will have to be profound changes. At the moment, people lobby their MPs, who are uniquely unqualified to make these decisions. May I suggest to my hon. Friend that one of the changes might need to involve a thorough review of the framework and guidance under which the National Institute for Health and Care Excellence operates?

[Nicola Blackwood]

My right hon. Friend makes an important point. It has been made by a number of colleagues today, and I shall address it later in my speech if he will allow me.

We want the UK to lead the world in fighting cancer. Survival rates in this country have never been higher, but we must go further. Medicines are a vital weapon in the battle against cancer, but we must not forget the bigger picture. More than half of people receiving a cancer diagnosis will now live 10 years or more; 96% of women diagnosed with breast cancer in England will live for a year after their diagnosis; 86% will live for five years; and 81% are predicted to live for at least 10 years. Improving outcomes for all cancers remains a priority for this Government.

Our mandate to the NHS sets out an ambition to make England one of the most successful countries in Europe at preventing premature deaths from all cancers, and we are working to achieve this through the implementation of the most recent England cancer strategy. As the hon. Member for Bristol West (Thangam Debbonaire) said, early diagnosis and prevention are essential to achieving that aim. The new faster diagnosis standard will speed up the diagnosis of all cancers. The new standard aims to ensure that every patient referred for an investigation with a suspicion of cancer is diagnosed or has cancer ruled out within 28 days. It is also important that we support further clinical research, as this can have a considerable impact on cancer survival rates, and that is exactly why the National Institute for Health Research spent £142 million on cancer research in 2015-16. And of course we must not forget the vital research carried out by the cancer charities, supported by the millions of pounds donated by members of the public each year.

The Government fully understand how important it is that people affected by cancer are able to access new and promising drug treatments, and we firmly believe that clinically appropriate drugs that are established as cost-effective should be routinely available to NHS patients. We all know that these decisions, which can be fiendishly complex, are never easy. We also know from long experience in this place that they should not be made by the arbitrary interventions of politicians. They must be clinically led and made on the basis of the best available evidence. They must also be frequently reviewed when new evidence comes forward. That is why it is right for NICE to play that role in providing independent, evidence-based guidance for the NHS on whether significant new drugs represent a clinically effective and cost-effective use of NHS resources.

If a drug is recommended by NICE, the NHS is legally required to fund it, and over the years many thousands of people in England have benefited from the cancer drugs that NICE has recommended. Those include transformative drugs for cancer, such as Herceptin for breast cancer, pembrolizumab for skin cancer and Zytiga for prostate cancer. Unfortunately, although we would all wish it were not the case, there are cancer drugs that NICE is not able to recommend as clinically effective and cost-effective on the basis of the available evidence, which is exactly why the Government established the cancer drugs fund in England. Since October 2010, we have invested more than £1.2 billion in the CDF, which has helped more than 95,000 people in England to access life-extending cancer drugs that would not otherwise have been available to them.

In July 2016, as colleagues will know, NHS England and NICE introduced a new operating model for the CDF that builds on that and ensures that it is placed on a more sustainable footing for the future. The new operating model is designed to achieve three key objectives: to make sure that patients have faster access to the most promising new treatments; to make sure that taxpayers get good value for money on drug expenditure; and to make sure that pharmaceutical companies are willing to price their products responsibly and can access a new fast-track route to NHS funding for the best and most promising drugs.

As part of the transition to the new operating model, NICE is looking at whether drugs that were previously available through the fund should be funded through baseline funding in the future. NICE has recently been able to recommend two of these drugs for breast cancer, Halaven and Afinitor, as well as a further breast cancer drug, Perjeta. These drugs will now be routinely available to patients. NICE was able to recommend each of these products by taking into account patient access schemes, a mechanism by which companies can improve the cost of drugs to the NHS.

As we are discussing today, NICE also reappraised Kadcyla. As the hon. Member for Mitcham and Morden rightly explained, NICE consulted on the draft guidance but was not able to recommend the drug for routine use because it is too expensive for its benefits. As my hon. Friend the Member for Milton Keynes South (Iain Stewart) rightly said, it is important to stress that NICE has not yet issued its final guidance on Kadcyla and will take stakeholders’ responses to the recent consultation fully into account in developing its final recommendations, which allows time for further negotiation between NICE and Roche. That is why today’s debate has been of value.

I fully appreciate that this is an anxious time for women with breast cancer, but I hope that all here today will appreciate that these are difficult decisions and that NICE must be able to make them free from political interference. I assure the House that, regardless of the appraisal’s outcome, NHS England will continue to fund Kadcyla through the CDF for all patients who have already begun treatment.

The hon. Member for Mitcham and Morden and others raised the importance of access to bisphosphonates for breast cancer patients, as well as the general use of off-patent drugs. The use of off-label and off-patent drugs is common in clinical practice, and there is no regulatory barrier to their prescription. NICE often considers off-label and off-patent drugs in guidance and issues advice to clinicians on new off-label uses of drugs.

The hon. Member for Torfaen (Nick Thomas-Symonds) made an important and informed speech on the issue that proved, in just over 10 minutes, exactly why he is the chair of the APPG. He is right that progress needs to be made in this area. The working group is about to review its latest progress in the next month, and I will certainly take up the issues that he raised with my colleague, the noble Lord O’Shaughnessy, who is responsible for this policy area. I will ask him to respond, especially on sharing the working group’s progress and providing an update regarding the publication of the “British National Formulary”, which the hon. Member for Wythenshawe and Sale East (Mike Kane) also mentioned.

The hon. Member for Torfaen would perhaps like to know that the Association of Medical Research Charities is also working with the Department of Health to facilitate and improve take-up of new robust research findings on repurposed drugs, where appropriate for the patient. I suspect he already knows that, however, given the nature of his speech.

For other colleagues who intervened on this point, bisphosphonates are medicines that are primarily used to prevent or treat osteoporosis. As colleagues clearly know, they are also used for a number of other medical conditions, including reducing the risk of primary breast cancer. That is based on the research in The Lancet in 2015, which found that bisphosphonates can be used to help women who are being treated for early breast cancer after the menopause by reducing the risk of the breast cancer spreading to the bone by 28%.

Bisphosphonates are not licensed for the treatment of breast cancer, but because there is good research evidence that supports their use, they can be prescribed to patients for that purpose when prescribers consider that that meets their clinical needs. There are concerns that access to bisphosphonates and their prescription is variable and that there may be some confusion at a local level as to who is responsible for commissioning them for such use, so I am happy to share NHS England’s advice on these points. While NHS England is, of course, responsible for commissioning specialised services, the manual for specialised services makes it clear that the decision to prescribe bisphosphonates for breast cancer rests firmly with the clinician and patient, subject to funding from the relevant clinical commissioning group.

Members may also be aware that NICE is updating its guideline on the diagnosis and management of early and locally advanced breast cancer. The use of bisphosphonates will be considered as part of the update. The revised guidance is due in 2018. Given the concerns about prescription, my officials have spoken to NICE about the timescale for the guideline, and I am pleased to say that NICE is looking at the feasibility of bringing forward the recommendations on the adjuvant use of bisphosphonates. It will of course be important to consider what the implications might be for the timescale for the remainder of the guideline. I am happy to keep the House updated on that decision.

The Government are not complacent about the availability of breast cancer drugs, and we continually look for measures to drive greater access to innovative new technologies. That is why the Government commissioned the independent accelerated access review, as mentioned by the right hon. Member for North Norfolk (Norman Lamb). Its final report in October set out how the UK can accelerate access to innovative cost-effective drugs, devices and diagnostics for NHS patients and create a more attractive environment for innovators and investors. The Government will respond to the review in the spring, but I acknowledge that NICE must continue to evolve to adapt to changes both in the development of new drugs and in the health and care system. Given the time, and if it is all right, I will respond on some of the details in writing to the hon. Member for Mitcham and Morden. We will continue to work with NICE to ensure that its methods remain fit for purpose.

We must remember that improving outcomes for cancer patients is not just about drugs. That is why we accepted all 96 recommendations in the independent cancer taskforce’s “Achieving world-class cancer outcomes” report. The recommendations represent a consensus of the whole cancer community on what is necessary to transform cancer care across the whole cancer patient pathway, from prevention and early diagnosis to living with and beyond cancer, including dealing with side effects, as was mentioned so movingly by the shadow Minister. We are implementing that through a strategy that was published in May and we hope to see great progress as it is delivered. As was made clear in the speeches of so many in the Chamber, breast cancer affects many people in this country today. We continue to invest so much in cancer services so that more people survive cancer and more people live better with cancer. To do that, they need rapid access to more effective treatment, be it surgery, radiotherapy or drugs. That is what I want to see and that is what this Government will deliver.

I am sure that the whole House will join me in congratulating all who have fought and survived breast cancer. We want to stand alongside everyone who is living with a breast cancer diagnosis, battling treatment and living with the sometimes hidden day-to-day impacts of breast cancer. We remember all those who fought valiantly but lost the battle with breast cancer. We have made much progress in improving care, providing drugs and funding research, but there is much more that we can and must do to fight this disease. I hope that each and every Member here will do what they have been doing today and hold the Government to account as we move on and try to do just that.

Stem Cell Transplants

Baroness Blackwood of North Oxford Excerpts

Tuesday 24th January 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I congratulate the hon. Member for Alyn and Deeside (Mark Tami) on securing this important debate and on his moving contribution. I also thank his co-chair, my hon. Friend the Member for Enfield, Southgate (Mr Burrowes), for his contribution, which was characteristically informed. I join them in thanking the all-party parliamentary group on stem cell transplantation and the Anthony Nolan trust for all their hard work and advocacy in this field on behalf of patients and their families. I particularly want to thank all those who have allowed their personal stories to be shared in the Chamber tonight. They are a powerful reminder of why we are all here. Their importance cannot be overstated.

As the hon. Gentleman said, stem cell transplants promise a life-saving cure for many patients, but the key is finding a suitable matching donor. While many patients are able to find suitably matched family members, for more than 1,000 patients a year, that is not possible and they have to rely on the generosity of others. I am sure that the whole House will want to join the hon. Gentleman in paying tribute to the more than 800 people in the UK this year who donated their stem cells.

I will go on to speak about improving patient care and the importance of research, as my hon. Friend mentioned, but both my colleagues raised commissioning as a particular concern, so I shall start there.

Over the past few months, there have been particular concerns raised regarding the commissioning by the NHS of second stem cell transplants for patients with relapsed disease. I recently had the chance to visit Anthony Nolan’s research labs at the Royal Free, where I was introduced to Emma Paine. Emma is alive today, as the hon. Gentleman said, thanks to a second stem cell transplant. She looks extraordinarily well and she is a powerful advocate for the cause. She spoke to me with extraordinary eloquence about the difficulties of the commissioning process, so I am in no doubt about the importance of the issue.

Decisions regarding prioritising specialised commissioning are always going to be difficult, which is why I believe that they are rightly a clinically led operational matter for NHS England, as the hon. Gentleman anticipated I would say. Knowing that I was coming here tonight, I asked for an update from NHS England. Contrary to some reporting on the issue, NHS England has not withdrawn the provision of second transplants. Second transplants have been, and remain, routinely commissioned for patients where the grafting process has failed, but NHS England has recently reviewed a proposal, alongside all the other priorities that were put forward, to begin routinely commissioning second transplants for patients with relapsed disease, for the first time since it was established in 2013. That would have replaced the current case-by-case provision of those transplants.

To prioritise funding for specialised services, as colleagues will know, NHS England has an established mechanism to evaluate proposals for new areas of investment. This reviews proposals on the basis of their clinical benefit and cost, as colleagues have discussed. The clinical benefit is based on the latest published clinical evidence.

As the hon. Gentleman said, that proposal was not approved. NHS England explained to me that its decision not to recommend routine commissioning of second transplants was based on the associated cost of the treatment, which the hon. Member for Strangford (Jim Shannon) mentioned, and the clinical evidence that suggests that less than one third of patients with relapsed disease survive more than five years after the second transplant. However, as I think colleagues mentioned, there is also evidence to suggest that, in that area, clinical practice is ahead of published evidence. For that reason, work is ongoing to ensure that the evidence base is updated before the decision is next reviewed.

Prioritisation decisions are kept under review in the light of new evidence and NHS England tells me that proposals for second transplants will be reviewed again later this year. Until the completion of any review, as the hon. Member for Alyn and Deeside said, clinicians can continue to apply for funding for second transplants for relapsed disease where NHS England assesses that the patient is clinically exceptional or has a clinically critical need, although I accept what colleagues have said about how difficult that process can be.

I shall certainly put to my colleague, the Minister of State, Department of Health, the point raised by the hon. Member for Alyn and Deeside about the transparency of decision making and the sensitivity in communicating that decision. I shall ask that my hon. Friend take it up with NHS England.

[Mark Tami]

Does the Minister accept that, for a whole host of illnesses, we fund, probably rightly so, drugs that may cost vast sums for people for whom the prognosis is that their lives might be extended by weeks, whereas we are now discussing not only extending people’s lives for years but potentially enabling them to live a full life over which they could pay back some of the cost of the treatment?

[Nicola Blackwood]

As a politician, I do not feel I am qualified to make the judgment about the different clinical priorities, which is exactly why that decision is supposed to be made by clinicians. We are, though, hearing that there is a difference between the published evidence that is going forward to the board for decision making and that at the coalface. That is what needs to be rectified before the decision is made. We are working hard to try to ensure that that happens so that patients such as Sasha, Emily and others have the best possible chance.

It is precisely because of the extreme stress and the fear of relapse that the hon. Member for Coventry North East (Colleen Fletcher) identified—the hon. Gentleman agreed with her—that in the meantime we are trying to focus our efforts on improving patient care and driving forward research, so that we can improve the outcomes of first stem cell transplants and explore all possible treatments and therapies for these very hard-to-treat conditions. That is why the Department of Health has not washed its hands of stem cell treatments. We have provided more than £19 million to our delivery partners, NHS Blood and Transplant and Anthony Nolan, since 2010, and a further £2.5 million this year.

Support from the Department is shaped by expert advice from the clinical community and has led to a number of tangible improvements that mean that patients are now significantly more likely to find a matched donor. Better matching of donor and recipient means that the stem cell transplants are much more likely to work the first time, which is a better outcome for the patient anyway. We have also supported the creation of a unified donor registry, which, combined with advances in tissue-typing, means that the time taken to identify a suitable donor has been significantly reduced. As many colleagues have said, patients in need of a stem cell transplant are often very ill and do not have time to waste, so that progress is very important.

Despite significant improvements in the chances of finding a suitable donor, there remains a global shortage of donors for patients from minority groups, which is unacceptable. That is why we are continuing to support the expansion of the cord stem cell bank. Stem cells from umbilical cords tolerate minor mismatches in tissue type, so are disproportionately used to treat patients from minority groups, for whom finding an exactly matched donor may be impossible. We are trying to combine that with the targeted recruitment of adult donors from under-represented communities. The chances of patients from minority groups continue to improve, but we recognise that there is still more to be done and are working closely with charities and hospitals to try to ensure that that happens.

Recent high-profile donor search campaigns, such as Match4Lara, have done a lot to help to raise awareness of the particular challenges that some patients face in finding a donor. Through that and other campaigns, Anthony Nolan has demonstrated the value of using social media to reach young people in all sections of the community. Overall, it is estimated that investment by the Department and the work of delivery partners such as Anthony Nolan means that, compared with 2010, more than 130 additional lives are being saved each year. We are making progress, but there is no complacency, and we recognise that more needs to be done.

[Mr Burrowes]

I am the first to congratulate the Government on making that investment, and on that commitment and partnership work. Nevertheless, is there not a mismatch? The investment commitment to collections at source is no doubt meant to ensure that there are outcomes in relation to transplantation. Our issue is that it seems that, at the end of the day, when a patient gets to the second transplant, which is sadly part of the complicated life-cycle for them, we seem to be just pulling the rug from under them.

[Nicola Blackwood]

My hon. Friend will have heard my answer on that. We are trying to address that as we go through the commissioning process by ensuring that the best possible evidence is there and that it is the most up-to-date clinical evidence, so that, through what has to be a robust prioritisation process, the second stem cell transplantation for relapse has the best possible chance. I also think that it is important that we address the other areas of stem cell transplantation to ensure that patients have the most improved outcomes at, for example, first transplant level, so that the research is available to feed through into that prioritisation process, and also so that patients have the best possible experience going through the process.

Finding a suitable donor is only the start of a long recovery process for patients, as Emma said very clearly to me. The report from the independent Cancer Taskforce, with which hon. Members are familiar, identified a number of ways in which people living with and beyond cancer could and should be better supported. In the case of patients receiving stem cell transplants, NHS England has set out the pathway in its service specifications. It is widely recognised that patients receiving a stem cell transplant often experience severe psychological and emotional stress. The aggressive nature of the treatment and the need for prolonged hospital stays mean that the psychological impact on patients can be particularly severe.

Transplant centres recognise that the long-term management of these effects is an important aspect of the transplantation process. It is important that we stay by those patients for the long term, as has been mentioned. There is also an urgent need to improve the clinical outcomes of stem cell transplants and to track those outcomes so that we have the evidence to present. The planned impact project is an important aspect in addressing the development of the best possible clinical practice. This network, supported by the charities, Anthony Nolan and Leuka, will complement the existing National Institute for Health Research clinical trials network. It aims to recruit 20% of stem transplantation patients into clinical trials. We believe that it is only through further research supported by clinical trials that the survival rates for these transplants can be improved.

During my recent visit to the Anthony Nolan laboratories, I was particularly impressed to see that they are involved in applying the latest genomics technology to improve the matching of donors and recipients. It is a clear example of how we are directly improving care and access through our research and through the 100,000 Genomes Project.

[Mark Tami]

I thank the Minister for giving way; she is being very generous. She has touched on a key point there, and it is something that I have raised with her before. We are rightly prepared to spend a large sum of money on treatment to give people the transplant they need. As she says, it is a very difficult process for the patient. Afterwards, there is virtually no support for that patient and for their mental health. They may have a lot of questions and a host of issues—a child, for example, may want to know why it has happened to them and why they look different—yet they really have to search for support. The support should be part and parcel of the whole package, rather than something that is applied as some sort of add-on.

[Nicola Blackwood]

The hon. Gentleman is absolutely right. It is very important that we look at the whole child as well as the psychological impacts of long-term illness—whether it is a cancer or any other kind of long-term illness. He will know that we are developing a Green Paper for children’s mental health, and I do intend, and hope, to be addressing the ways in which we can look at not only the broad spectrum of children’s mental health, but those who have particular challenges that they need to overcome. He has raised the matter with me before. I gave him a commitment that I would follow through on it, and I reassert that commitment tonight.

The way in which we are working on this, which is to build up the research to improve patient care and to ensure that we are allowing the NHS to deliver world-leading therapies based on genetic information, is essential to ensuring that every patient receives the appropriate treatment. That is what colleagues say they want to happen. It also highlights the importance of having the right infrastructure in place throughout the NHS, because if we do not have that, we will not be able to provide the best support.

That is why we announced in September an £816 million investment for biomedical research centres over the next five years. We also specifically support translational research into stem cell transplantation through the stem cell and immunotherapy research unit—one of four NIHR blood and transplant research units, each of which is a partnership between a university and NHSBT. The stem cell unit at University College London is involved in the development of new and potentially transformative forms of treatment involving immuno- therapies. Such therapies are perhaps the most exciting and promising area of cancer therapy and may eventually entirely replace the need for stem cell transplantation. I appreciate, however, that those advances cannot come soon enough for the patients mentioned tonight.

As ground-breaking as our research efforts undoubtedly are and as necessary as they are for the long term, we must always remember that research is not an end in itself. Ultimately, we are all working to deliver better, more targeted patient outcomes that offer hope to the thousands of people living with an incurable condition. In doing so, we must ensure that we are helping to improve the lives of those patients and their families while we work to transform NHS care for generations to come. That is what we are working to deliver. I hope that the hon. Member for Alyn and Deeside and my hon. Friend the Member for Enfield, Southgate will work with me as we try to do that.

Question put and agreed to.

Employment, Social Policy, Health and Consumer Affairs Council: December 2016

Baroness Blackwood of North Oxford Excerpts

Friday 20th January 2017 Written Statements

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

The Employment, Social Policy, Health and Consumer Affairs Council met on 8 December in Brussels. For the health part of the meeting, the UK was represented by the Deputy Permanent Representative to the EU. The meeting featured one substantive item about the European semester and health, and a number of other items as part of the “any other business” section of the agenda.

On the topic of the European semester, the UK stressed member state competence and the importance of maintaining a narrow focus for the semester. Regarding the involvement of Health Ministers in discussions about the semester, the UK stated that it had no objection to focused discussions, although added that Health Ministers are already engaged through national co-ordination. Discussions about this issue will continue under the Maltese presidency.

Under the AOB part of the agenda, the UK presented on the candidacy of Dr David Nabarro for Director-General of the World Health Organisation (WHO). The UK emphasised Dr Nabarro’s UN experience—including on cholera, food security and sustainable development—and stressed that he has demonstrated a reform-minded approach and is committed to transforming organisational effectiveness. The UK stated that he had the backing of the Prime Minister and chief medical officer.

On antimicrobial resistance (AMR), the UK stressed the importance of keeping up momentum following the recent agreement of a declaration on AMR at the UN General Assembly, and outlined areas where work needed to be focused; including on research and innovation, the development of new products, on implementing national action plans and on benchmarking.

There were also discussions on alcohol, about the production of paediatric medicines, and about follow-up work relating to Council conclusions on pharmaceuticals. The EU Commission provided an update on European reference networks, as well as feedback about the report “State of Health in the EU”, which it has jointly published with the Organisation for Economic Co-operation and Development. There was also an update about the discussions held at the recent conference of the parties to the WHO framework convention on tobacco control.

Finally, there were updates about recent conferences, and Malta provided an overview of priorities for its presidency, commencing on 1 January.

[HCWS425]

Pharmaceutical Price Regulation Scheme

Baroness Blackwood of North Oxford Excerpts

Friday 20th January 2017 Written Statements

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

On 23 December 2016, the Government published the level of payment due from members of the Pharmaceutical Price Regulation Scheme (PPRS) in 2017 to keep health service spend on branded medicines within the levels agreed under the scheme.

The Department of Health and the Association of the British Pharmaceutical Industry have agreed in principle to amend chapter 6 of the 2014 PPRS in accordance with paragraph 3.4 of the scheme in order that the scheme continues to deliver its agreed objectives of predictability and stability to Government and industry, and to ensure that the cost of branded medicines to the NHS stays within affordable limits. The effect of the changes is that the payment percentage for 2017 is to be set at 4.75% for 2017, and the 2018 PPRS payment percentage will be determined by reference to the existing PPRS payment mechanism, provided that the resulting percentage falls within the lower and upper limits of 2.38% and 7.80%. The Government recognises the additional contribution being made by the pharmaceutical industry in acknowledgement of the financial challenges facing the NHS.

The Department has published a document setting out further details entitled “Pharmaceutical Price Regulation Scheme (PPRS) 2014: revised payment percentages at December 2016”.

Pharmaceutical Price Regulation Scheme (PPRS) can be viewed online at: http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2017-01-20/HCWS426/.

[HCWS426]

Children’s Mental Health In-patient Services

Baroness Blackwood of North Oxford Excerpts

Friday 20th January 2017 Written Statements

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I would like to update the House following a point of order on this issue on 12 April 2016 (Col 183) made by my predecessor, the right hon. Member for North East Bedfordshire (Alistair Burt), former Minister of State for Community and Social Care, who met the voluntary and community sector organisation that brought this issue to light with the BBC. He was able to have a useful discussion with them on the key problems and potential solutions. He made the commitment to look into this issue and set out how this will be improved in the future.

Deaths in children’s in-patient mental health services are rare events. Every preventable death, especially in young people, is a tragedy and it is important that they are properly recorded so that lessons can be learned and action taken where necessary. There can be particular challenges in the way deaths are registered and classified. There can be a time lag before an inquest concludes on the cause of death and where a young person is concerned; there may be a lack of clarity around intent, so that the cause of death may not be classified as suicide.

Officials have now made a detailed assessment of the available data. I can confirm that there have been 11 deaths of patients under the care of mental health in-patient services, both inside and outside of the premises since January 2013. It is not possible to provide an accurate figure on the number of deaths prior to this time period, due to the commissioning arrangements and data collection methods which were in place at that time. It is with regret that I cannot provide a figure for this earlier time period. However, I am fully committed to making sure that we are able to improve on this in the future.

Following assessment of the data, the right hon. Member for North East Bedfordshire brought into effect increased oversight in this area. As of June 2016, both the Minister with responsibility for mental health and the Secretary of State for Health receive an immediate report of any death in a children’s in-patient mental health setting or on home leave from such services where they occur. We will simultaneously notify the National Confidential Inquiry into Suicide and Homicide if a self-inflicted death has occurred in these circumstances, so that both the figures and clinical lessons can be captured as part of annual reports, which will be made available to Parliament. This will provide insights for national and local organisations to take on board. We have written to providers of children’s mental health in-patient services to remind them of the responsibilities of their reporting duties.

A report by the National Confidential Inquiry into Suicide and Homicide on Suicide in Children and Young People, which was published on 26 May 2016, shows that 60% of those who had died had not been in contact with mental health services at all. This illustrates the urgent need to make sure that children and young people can access mental health services to prevent such tragedies in future. The ambitious transformation programme that has been put in place to ensure that young people receive the support they need is designed to do just that.

We know that we need to improve the system of investigating deaths of mental health patients. The Government and local providers are working hard on the implementation of the Mental Health Taskforce report which will address these issues, and the House will be kept informed. Also, the Secretary of State recently announced a series of measures in response to the Care Quality Commission’s report “Learning, candour and accountability” that will require NHS trusts and foundation trusts to improve their understanding of deaths arising from problems in care and demonstrate the learning and action that follows.

On behalf of both previous and current Ministers, I am grateful to those who have brought this matter to our attention in the House.

[HCWS427]

NHS Fertility Services

Baroness Blackwood of North Oxford Excerpts

Thursday 19th January 2017 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

It is a pleasure to serve under your chairmanship, Mrs Gillan. I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe), my right hon. Friend the Member for Wantage (Mr Vaizey) and the right hon. Member for Carshalton and Wallington (Tom Brake), who is not in his place, on securing this important debate. I am grateful for the opportunity to discuss NHS fertility services. This has been a moving debate and, on behalf of the Government, I recognise at the outset that infertility is a serious condition, affecting a growing number of people: women and men and same-sex couples. I personally thank all of those who have allowed their stories to be shared today. They remind us powerfully of the distress that infertility causes. The value of their being shared in the debate cannot be overstated.

It is important to remember that those stories are not isolated cases. As hon. Members are well aware, fertility problems are estimated to affect one in seven heterosexual couples and, for couples who have been trying to conceive for more than three years without success, the likelihood of pregnancy occurring in the following year is 25% or less. We should keep those figures in our minds.

As my right hon. Friend said, infertility can and does have a powerful and lasting impact on the quality of life of those affected. Research has shown that there can often be psychological effects, as powerfully described in the debate, for both men and women suffering from fertility problems. It can cause stress and it puts pressure on relationships, primarily between the couple themselves but also on relationships with family and friends. It is therefore important that the NHS provides access to fertility services for those who need clinical help to start a family.

The availability of NHS fertility treatment is and always has been a matter for local determination. As my right hon. Friend said, these are not easy decisions to make, but we expect them to be made fairly. Decisions on the level of service provision are underpinned by clinical insight and knowledge of local healthcare need. That has been the case since the introduction of the purchaser-provider split in the 1990s, and today that determination is, as we all know, made by CCGs, which are clinician-led and have a statutory responsibility to commission healthcare services that meet the needs of their whole population, reducing inequalities and improving care quality.

While provision of services will, by necessity, vary—for example, the health needs and priorities of the population of Birmingham will not be the same as that of Bournemouth—it is right that those difficult prioritisation decisions are led by clinicians who know their patients and local areas best rather than being made centrally. The Government have made it clear that blanket restrictions on any healthcare treatment—including fertility services—are unacceptable. Where a service is not routinely commissioned, clinicians can still make individual funding requests for their patients when a clinical case can be made and if treatment is likely to provide significant benefit. It is the role of NHS England to ensure that CCGs are not breaching their statutory responsibility to provide services that meet the needs of their local population and to take action if such breaches do take place.

[Steve McCabe]

I recognise what the Minister says about this being an issue for local determination. However, does she agree that it does not make sense to use moralistic criteria to ration the provision of services, which—as in the example I cited in Birmingham—is then put to a public poll that produces an inconclusive result on a very low turnout? Surely that is not the kind of local determination we want. Is that not something that NHS England should act on?

[Nicola Blackwood]

The hon. Gentleman gave a very good opening speech in which he raised some points that I will comment on. The quality of commissioning of fertility services is one of those points, and having regard for guidance already in place to guide local commissioners in commissioning fertility services is a point on which I am about to comment. He has anticipated my speech as only a seasoned politician can.

NICE first introduced its fertility guidelines in 2004. As with all clinical service guidelines, they have never been mandatory. Successive Administrations have supported the principle of locally determined implementation of key recommendations of the guidelines, because decisions about local services should be made as close to patients as possible by those best placed to work with patients and the public in their area to understand their needs. However, it is sadly the case that implementation has been variable over the years, particularly with the provision of three IVF cycles for qualifying couples, as we have heard. As the hon. Member for Birmingham, Selly Oak and the shadow Minister rightly said, the 2016 Fertility Fairness survey showed that just 16% of CCGs provided the recommended three cycles of IVF, with 22% providing two, 60% providing one and 2% providing no IVF funding at all.

I understand that commissioners in some areas are undertaking their own evidence reviews, as the hon. Member for Birmingham, Selly Oak said, to determine whether their CCG should offer IVF. I take this opportunity to say that that is unnecessary. NICE was established for the specific purpose of reviewing the available clinical and scientific evidence of a treatment’s effectiveness and, working with a wide range of stakeholders, to make recommendations based on that evidence about services that should be available to all within the NHS. NICE guidelines for fertility services are robust and fit for purpose, and there is no need for them to be second-guessed by commissioners.

The hon. Gentleman also raised NICE guidelines for same-sex couples. NICE guidelines seek to offer heterosexual and same-sex couples the same access to investigation and treatment for fertility problems, the criterion for which is a failure to conceive over a set period of time. NICE sets that criterion to ensure that NHS funding is available for donor sperm for female same-sex couples, or surrogacy arrangements for male same-sex couples, on the basis that they are medically sub-fertile, not that their childlessness is owing to the absence of gametes from the opposite sex—sperm or eggs.

Access to NHS-funded investigations is commissioned in female same-sex couples who fail to conceive after six cycles of artificial insemination within a 12-month period. NICE recognises that same-sex couples could be disadvantaged, because they may have to pay for artificial insemination before they can be considered for NICE assessment and possible treatment. NICE considers six cycles to be equivalent to the 12-month period of unprotected intercourse required of heterosexual couples before they are offered investigation for fertility problems. Same-sex couples are offered access to professional consultation and advice in reproductive medicine before they embark on attempts to conceive, to ensure that they are informed about appropriate and safe self-funding attempts. I can tell the hon. Member for Birmingham, Selly Oak that NICE is due to review its fertility guidelines this year, and he may wish to write to NICE’s guidelines review team to offer his views on the issue. The Department of Health will certainly be doing so.

On the implementation of NICE guidelines, I commend CCGs, such as Camden, Oldham and others that have been mentioned, that have implemented the NICE fertility guidelines in full and continue to offer three IVF cycles to qualifying couples. That shows it is entirely possible for CCGs to implement NICE’s IVF provision recommendations. It was disheartening to learn from the Fertility Fairness survey that access to IVF treatment on the NHS has been reduced in so many places, and it is deeply disappointing that some CCGs have stopped routinely commissioning it. I strongly encourage all CCGs to implement the NICE fertility guidelines in full, as some CCGs are successfully doing.

[Justin Madders]

The Minister has correctly identified that some CCGs are not providing any treatment at all. Does she think that blanket policy should be dealt with?

[Nicola Blackwood]

I am about to go on to work that we are doing to assist CCGs with better commissioning, including giving them advice on pricing, which the shadow Minister mentioned. Perhaps he will allow me to do that; I think it will be enlightening for him.

Work is under way to assist CCGs in better commissioning fertility services for their local community. It is right that we do that. My right hon. Friend the Member for Wantage was correct—the cost of IVF is falling, but not all CCGs are benefiting from that. We know that the prices that fertility clinics charge CCGs for an IVF cycle vary, and that some CCGs are not contracting in the most effective way.

The Fertility Fairness survey reported that the price being charged by service providers for an IVF cycle varied across the country, from around £2,000 at the bottom end to more than £6,000 at the top, although it is not clear what all of those treatment cycles involve. The Department of Health, NHS England and professional and stakeholder groups are working together to develop benchmark pricing for fertility services to ensure that CCGs get the best value for their money. That is obviously the first step to be taken before NHS England’s longer term work towards developing a national tariff, which my right hon. Friend called for.

In addition to that initiative, the national fertility regulator—the Human Fertilisation and Embryology Authority—is developing commissioning guidance that aims to improve the quality of commissioning, for example by encouraging greater use of single embryo transfers where appropriate for a patient. That does not reduce the chance of a woman having a baby but significantly reduces the incidence of multiple births, with their attendant risks and complications for mothers and their babies. NHS England has agreed to disseminate and promote that guidance to all CCGs in England.

Those approaches are intended to raise the level of knowledge and expertise within CCGs to ensure that they are able to commission services appropriately in what is a specialist area, exactly as my hon. Friend the Member for South West Bedfordshire (Andrew Selous)—who is no longer in his seat—called for. It would also be helpful for CCGs to pool their resources and expertise and collaborate more with each other to get a better deal for their patients. That has happened in the north of England, where members of two commissioning collaboratives are able to offer three IVF cycles to qualifying couples.

As I hope has been clear, it is the Government’s view that infertility is a serious medical condition. Those suffering from infertility who meet the criteria in the NICE fertility guidelines for NHS-funded treatment should be able to seek that treatment. We do not agree that clinical infertility should not be part of a comprehensive national health service. Reflecting on the strength of feeling expressed today, I will be writing to NHS England to ask that it communicates clearly to CCGs the expectation that NICE fertility guidelines should be followed by all.

The Department of Health, NHS England and professional and stakeholder groups will redouble efforts to develop the benchmark pricing for fertility services, which, as I have said, is a precursor to NHS England introducing a national tariff. NICE will continue with its review of fertility guidelines this year. I hope that series of actions demonstrates just how seriously the Government take this situation, and leaves all those watching the debate confident of our commitment to finding practical solutions to this serious problem.

Musculoskeletal Services: Greenwich

Baroness Blackwood of North Oxford Excerpts

Wednesday 11th January 2017 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

It is a great pleasure to serve under your chairmanship, Mr Hanson. I congratulate the hon. Member for Eltham (Clive Efford) on securing this debate. I know that the subject is extremely important to him and his constituents. He has very eloquently raised the different concerns, which is no less than I would expect of him from our shared days on home affairs matters. I would warn him, however, that I doubt whether I will be able to answer every single one of his questions in detail. I will endeavour to get through the best I can and then reply with further detail in writing.

First, I would like to pay tribute to the many staff who work exceptionally hard every day for our NHS and deliver high-quality care for patients. As the daughter of an NHS doctor and nurse, who are now retired, I have seen at first hand how much personal sacrifice that involves from both NHS workers and their families, who often have to spend a lot of time apart from their dedicated NHS family members. It is a sacrifice that I am sure all of us here today would like to honour, especially during this busy time.

It is important to say at the outset—I know the hon. Gentleman is aware of this—that procurement of local health services by means of competitive tendering is a matter for the local NHS. Greenwich clinical commissioning group, which is the deciding body in this case, is a clinically-led independent statutory organisation. We believe it is right that local NHS systems are best placed to understand the health needs of their local populations and to use that knowledge to commission services for local people, to ensure the best clinical outcomes for all patients at the highest quality and best value to the taxpayer.

I know the hon. Gentleman knows that musculoskeletal services are currently provided to about 9,500 Greenwich patients by the four NHS trusts and one private provider, but despite the hard work of local health workers, the latest data show that Greenwich CCG’s referral rate to treatment trauma and orthopaedics performance is only 80.8%, against a target of 92%. It also shows a high number of out-patient appointments—more than 50% higher than the national average—with many seeing a consultant surgeon and then not having surgery. That paints a clear picture of too many patients waiting for too long. Even when they do get an appointment, they do not always see the right health professional, which means another wait for physio or other interventions.

As someone who has a chronic, complex illness and was misdiagnosed for more than a decade, I understand how dispiriting it is to wait in pain only to endure the disappointment of inappropriate or unnecessary appointments or tests and to end up on a new waiting list still in pain, just more frustrated. I know that because I lived it. We have to do better to get the right care to the right patients in the first place.

Taking such steps not only improves patient care and their experience of the NHS, but cuts out wasted appointments and tests, and frees up hugely valuable consultant and technician time, saving money that can be spent on appropriate care instead. That is why the CCG identified the musculoskeletal hub model, which has been successfully implemented using a range of different kinds of providers, private and public—I am agnostic on that point—across the country. It concluded that it would secure better value for money from that more streamlined service model, especially at the point of referral.

Given the hon. Gentleman’s description, I think he knows this, but I will say it anyway: the hub model means identifying one healthcare provider to act as a single point of access for all Greenwich musculoskeletal patients. That healthcare provider then offers patients who need an in-patient operation a choice of where the operation takes place. It is also able to triage patients more effectively into physio and other non-surgical treatments sooner, which means that surgery can often be prevented because it is possible to intervene quicker, which is better for patients.

The hon. Gentleman expressed concern in his parliamentary questions about the procurement process. However, I am sure he welcomes the fact that there was some consultation prior to procurement. He questioned the information that has come to me, and I will double-check it, but I have been told that the draft specification was shared with the CCG patient reference group and the pensioners forum for their comments prior to finalisation. When the musculoskeletal service was put out to tender in April 2016 in an open procurement process, the prospective bidders were required to put forward a programme budget within the range of £14 million to £14.8 million a year.

[Clive Efford]

Lewisham and Greenwich NHS Trust made about 50 requests for information about the scope of the contract it was being asked to bid for during that process, and it received very few responses from Greenwich CCG. It is very difficult to say that there was adequate information or consultation about the impact of the service, because very little information came from the CCG.

[Nicola Blackwood]

I am sure more information could have been made available, but there certainly were attempts to engage with patients to ensure the contract was shaped to meet patient need.

In the end, two bids were received. They were anonymised and evaluated by a panel that included clinicians. According to the information I have received, the CCG had at least four GP members in attendance at the governing body meeting of 29 June, as well as three other voting members. The musculoskeletal specialist was from another area, specifically so that the panel could benefit from his experience without risk of conflict. Following the evaluation section of the meeting, all members with a conflict of interest were asked to leave the room, as the hon. Gentleman said. Those members’ votes were transferred to other governing body members, in line with the CCG’s constitution. I am not sure where the hon. Gentleman’s information about the numbers in the meeting comes from. According to the information I have received—which I will check—the remaining members of the CCG governing body then voted, and the meeting was quorate, in line with the actual numbers in the room. They voted on the still anonymised bids. Following that process, the five-year contract was awarded to Circle Health. The bid was assessed by NHS England to be according to the NHS standard procurement process, which is obviously legal.

As the hon. Gentleman said, under the proposed model, Circle will triage all patients registered with a Greenwich GP who require physiotherapy or planned orthopaedic surgery to ensure they receive the most appropriate medical professional support the first time to avoid inappropriate patient experiences. The aim is to reduce the number of first out-patient appointments, because many have been found clinically unnecessary. Further, if the trust experiences fewer unnecessary out-patient appointments, surgeons will have more time to carry out elective surgery, which will reduce waiting times for those who really need it. Over the lifetime of the contract, the CCG expects the average waiting time at Lewisham and Greenwich NHS Trust to reduce from 7.8 weeks to below 7 weeks.

As I said, regardless of the details of the procurement, which we will check, ensuring that patients are better served with the right care at the right time must be something that colleagues from across the House support. I heard the hon. Gentleman’s concerns about the impact on existing services and his view that the assessment should have been carried out further. At any rate, I am pleased it is being carried out now. As I understand it, Greenwich CCG discussed the procurement with Greenwich Council’s healthier communities and adult social care scrutiny panel—which is very snappily named —at a meeting on 3 November. The panel accepted that the process had been correct, but due to the level of public concern it requested that the CCG and the trust co-commission an independent assessment of the likely impact on orthopaedic activity at Lewisham and Greenwich NHS Trust and also that the outcome of that assessment be shared with the HCASC prior to the CCG’s signing the contract. That is what is happening, and it is clearly the right thing to do.

The main concern raised by the HCASC is that the trust may see a reduction in elective orthopaedic activity, as the hon. Gentleman said, which would affect trauma services. The impact assessment will review the likelihood of a range of impacts—from a minus 40% shift in elective orthopaedic surgery to a plus 40% shift—and the resulting effect on local trauma services, emergency department services and other interdependent services at Queen Elizabeth hospital, as well as the risk to the clinical and financial viability of the trust. It will also consider the potential impact, should there be such a shift in orthopaedic surgery, on sustaining undergraduate and postgraduate training, capacity plans and backlogs, interdependent clinical services, the delivery of the national constitution standards for referral to treatment, and the implications on future recruitment of orthopaedic clinicians and support staff. Those are the parameters that were requested by the trust and others, so I think we can be confident that it will achieve its purpose.

The impact assessment is due to be presented to the Greenwich CCG board on 22 February. The report will be shared with the healthier communities and adult social care scrutiny panel the following day and published on the CCG website. The outcome of the assessment remains to be seen, but I am sure the hon. Gentleman agrees that it is essential that the CCG proceeds with what has clearly become a highly politicised decision with the best interests of patients as its core priority. As I said, the data show that we need to work to improve care for musculoskeletal patients in Greenwich, to ensure that all patients are getting the right care at the right time.

Question put and agreed to.

Children’s Wellbeing and Mental Health: Schools

Baroness Blackwood of North Oxford Excerpts

Tuesday 10th January 2017 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

It is a pleasure to serve under your chairmanship, Mr Nuttall. I thank the right hon. Member for North Norfolk (Norman Lamb), his colleagues and the Children’s Society for initiating this debate. As ever, I pay tribute to his continuing personal commitment to improving mental health services, not only as my predecessor but also through chairing the commission on children and young people’s mental health for the Education Policy Institute. That work has been extremely valuable to us.

The right hon. Gentleman is quite right to say that today’s debate is both timely and hugely important. As many colleagues have demonstrated in their comments, we know the distress that mental health problems cause to individuals and those who care for them. Some 10% of children have a diagnosable disorder—700,000 in the UK—and they are twice as likely to leave school with no qualifications, four times more likely to become drug dependent and 20 times more likely to end up in prison. He could not have put it better. There is a compelling moral, as well as social and economic, case for change. We know that if we can get our children and young people the help and support they need early on, when problems first arise, we can make sure that the problems do not become entrenched. That is why the Prime Minister was clear in her determination to improve mental health services and tackle the burning injustice of those with mental ill health having a shorter life expectancy.

As has been discussed, the measures announced by the Prime Minister particularly tackle children and young people’s mental wellbeing and build on the substantial work already in train to implement “Future in mind”. We will continue that work, so that we can go further and faster in intervening earlier more often. In driving those reforms forward, one of the challenges we still face—the right hon. Member for North Norfolk identified this when he was a Minister—is the “fog” when trying to identify and pinpoint the best treatment and support for those with mental health problems. We need to base policies on the most robust evidence possible, so that we can be sure that we are providing the care that people need at the right time and in the right way.

That is why the Department for Education is conducting a large-scale school survey on the activities and approaches used in schools to support children and young people’s mental health in order to find out what works best, and why the Prime Minister requested that the Care Quality Commission undertake an in-depth thematic review—the first of its kind. That is also why we are carrying out a prevalence survey on children and young people’s mental health—the first since 2004, which was before YouTube, Twitter or Snapchat. The survey will look at issues such as cyber-bullying and the impact of social media for the first time, and it is on course to report in 2018. It will fill an important gap in our understanding.

As the right hon. Member for North Norfolk knows, I believe very strongly that transparency in mental health services has lagged behind that in acute services. At a national level, data on children and young people’s mental health services were included in the new mental health services data set for the first time in January. It is still early days, but as collection improves, new metrics to monitor delivery are becoming available. We know from experience in acute services that that does improve accountability, standards and safety for patients. I will respond in detail to the comments of the shadow Minister, the hon. Member for Worsley and Eccles South (Barbara Keeley) about her letter—I do not have time to do that properly right now—but we are looking at how we can drive accountability, eradicate all shadow of confusion from clinical commissioning groups about how they should be reporting, and make sure that we get that data set exactly right. As recommended by the taskforce, we will publish a 10-year research strategy to ensure that the evidence-gathering is sustained. A new policy research unit for mental health will be established in 2017 to make sure that the research continues to become a reality.

While all the evidence-gathering is going on, we cannot stand still. That is why we will press ahead with the implementation of “Future in mind”. As the right hon. Member for North Norfolk said, some areas are performing well and improving, some need to get the message about why this is important, and others are coming from such a low base that they are still working on capacity building, so we are not seeing evidence of improvement yet, but we are clear that we are ambitious not only to deliver “Future in mind” but to go further upstream and intervene earlier to prevent problems. The evidence base that we are building will come together to support the publication of the Green Paper, with increasing focus on preventive activity across all delivery partners. The Prime Minister committed initially to a new focus on schools, colleges and local NHS services working more closely together to provide dedicated children and young people’s mental health services. We are supporting schools and the NHS to develop work by evaluating models and approaches and exploring the impact that closer working can have. We will initially support that by funding the provision of mental health first aid training for teachers in secondary schools—we know that that works. That is our start. I am going to do the training in the next few weeks, to see exactly why it works.

As we know, the Prime Minister also launched a refreshed programme of activity on peer support in schools and online to help young people, through providing access to well-trained mentors, as well as comprehensive support structures to help identify issues and prevent them from escalating.

[Mrs Moon]

I urge the Minister to make sure that the Government look at best practice across the devolved Administrations. It is not a case of reinventing the wheel; let us look at what works elsewhere and incorporate that.

[Nicola Blackwood]

Absolutely. We are also looking at increasing support for schools by finding the evidence of what is proven to work in their approaches to mental wellbeing. That will be achieved by a programme of randomised control trials of promising preventive programmes across the country. As the hon. Lady also mentioned, the refreshed suicide strategy has a particular focus on self-harm, which is causing so many problems in schools.

To make the measures work and to see the progress that we so desperately need, we have to work closely with colleagues across Government. As colleagues have said, schools and colleges have an important role to play in supporting children and young people’s mental health. That role is not only laid out in statutory safeguarding guidance but is one of the four areas of Ofsted judgment in the new common inspection framework.

Colleagues are right: if we are to expect schools to play this role, we must give them the right training and resources. In 22 pilot areas, which include 255 schools across the country, NHS England has been trialling a single point of contact in schools. That programme has tested improvements in joint working between school settings and specialist mental health services—particularly improvements in local knowledge and identification of mental health issues—and it aims to develop and maintain effective local referral routes to specialist services to ensure that children and young people have timely access to specialist support where required. It is also testing the idea of a lead contact in schools and specialist mental health services and examining how different areas choose to put that into practice. The work is being independently evaluated by Ecorys, and the final report will be available in the spring. The question is whether that system is more effective than having an individual counsellor in every school. We are looking at that.

Other support available includes Government-funded PSHE Association guidance, and lesson plans on how to teach mental health across all four key stages. A range of training on how to recognise specific mental health issues is available to all professionals who work with young people through the MindEd website; our analytics have shown that teachers are the largest single group of registered users on the MindEd tool. As the shadow Minister said, mental health and wellbeing is an evolving and vital area of education, and we need to make sure that it is fit for children growing up in modern Britain, so the DFE is looking again at the case for further action on PSHE and sex education provision, with particular regard to improving quality and accessibility. I am sure that it will keep the House updated on that.

The right hon. Member for North Norfolk is absolutely right that school counselling can turn around a child’s whole life trajectory, so schools are encouraged to provide counselling services, and the DFE has produced guidance on good school-based counselling as part of a whole-school approach to wellbeing. It has also published advice on behaviour and mental health, which provides teachers with information, and with tools to help them identify pupils who need help and to give effective early support in understanding when a referral to a specialist mental health service may be necessary. An advisory group, including sector experts and young people, looked at what good peer support for mental health and wellbeing looks like and considered how to encourage good practice in schools, community groups and online. There is much greater recognition that the earlier we pick up these things, the better it is for young people and their mental health.

The “Children and Young People’s Mental Health: Time to Deliver” report from the right hon. Member for North Norfolk found that we are making progress in many areas of the country, but not nearly enough to be complacent. I agree completely with that. We are restless in our ambition not only to drive delivery of “Future in mind” in all areas, but to go further and deliver upstream interventions to prevent problems, rather than waiting until the need for treatment. I hope that I have convinced the right hon. Gentleman that this is an area to which we are fully committed, and that we will continue to drive forward with his agenda.

Question put and agreed to.

Resolved,

That this House has considered the matter of supporting children’s wellbeing and mental health in a school environment.

Oral Answers to Questions

Baroness Blackwood of North Oxford Excerpts

Tuesday 20th December 2016 Commons Chamber

[David Tredinnick (Bosworth) (Con)]

2. What his Department’s definition is of evidence-based medicine; and if he will make a statement.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

Evidence-based medicine is about using high-quality research to guide clinical practice and to achieve optimal results for all patients. The National Institute for Health and Care Excellence plays an important role in supporting evidence-based medicine by translating research into authoritative guidance for healthcare professionals on best practice.

[David Tredinnick]

Is the Minister aware that the author of “Evidence-based Medicine” in 1992, Professor David Sackett, said that it is

“about integrating individual clinical experience and the best external evidence, not just internal evidence”?

Is she further aware that in respect of the interpretation of evidence-based medicine, I have reported the so-called Good Thinking Society to the Charity Commission for the abuse of its charitable status through its use of legal threats to force the Department and health providers to change the law on healthcare?

[Nicola Blackwood]

NICE obviously considers complementary and alternative medicines when developing its guidance, where there is evidence, and it has been able to recommend some therapies, such as acupuncture for tension headaches and a range of complementary medicines for multiple sclerosis. We expect healthcare professionals to take that guidance into account when designing local services, but they must use their best understanding when treating the individual patients in front of them.

[Keith Vaz (Leicester East) (Lab)]

The evidence is very clear that eating more sugar increases the risk of diabetes. Apart from introducing the sugar tax, what further evidence-based research can be used by the Government to reduce the risk of diabetes?

[Nicola Blackwood]

The right hon. Gentleman is a great proponent of tackling the risk of diabetes. He knows that the Government take tackling and preventing diabetes extremely seriously. That is why we have introduced the world’s first national diabetes prevention programme, which we have piloted and are rolling out across the country. It includes not only education programmes but testing, and we are making sure that we use the evidence from the programme to bring about improvement and that we are rolling it out effectively.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

We are all in favour of evidence-based medicine. We are also in favour of decent resources for the national health service but, in the case of Huddersfield and Calderdale hospitals, what we want is good, high-quality management, rather than GPs being promoted to a managerial position that they cannot handle.

[Mr Speaker]

In relation to evidence-based medicine.

[Nicola Blackwood]

The hon. Gentleman is a great advocate of evidence-based medicine and I am pleased to hear about his support for it. He will be pleased that the national leadership programme is one of the evidence-based programmes that we are rolling out to improve the leadership of the NHS across the country.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

3. How the Government plan to show global leadership in tackling antimicrobial resistance.

[Chris Green (Bolton West) (Con)]

14. How the Government plan to show global leadership in tackling antimicrobial resistance.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

The UK is already a global leader in the fight against AMR. This Government’s leadership has secured a UN declaration on AMR and a commitment from the G20 to drive the development of new antimicrobials. We will continue to deliver international programmes to tackle AMR, including the Fleming fund and the Global AMR innovation fund, which represent more than £300 million of investment over the next five years.

[Kevin Hollinrake]

One of the 10 key recommendations of the O’Neill review was to improve the data and surveillance underlying antimicrobial resistance. What plans does the Minister have to routinely test all NHS patients for antibiotic resistance?

[Nicola Blackwood]

My hon. Friend is absolutely right that it is essential that we improve diagnostics if we are to tackle this national threat. A routine part of the clinical management of patients showing symptoms of infections is to take a blood sample. When an infection is identified, those samples are indeed tested for resistance. Part of our AMR strategy is to improve diagnostics and to fund innovation in this area.

[Mrs Villiers]

Will the Government commit themselves to ensuring that their strategy will include discouraging the use of intensive farming, given its overuse of antibiotics which contributes to antimicrobial-resistant problems?

[Nicola Blackwood]

I agree that we must focus on that as well, but we are currently focusing on reducing the need for antibiotics by minimising disease risk in animals through good animal husbandry and on-farm biosecurity. At present, antibiotics provide the only effective means of treatment for a number of animal diseases, and are therefore essential to ensuring the health and welfare of animals. However, we are also working on the matter in an international context with the World Organisation for Animal Health, and we will continue to drive forward the agenda.

[Chris Green]

What measures are the Government introducing to support the uptake of point-of-care C-reactive protein testing throughout the United Kingdom, given that it is a proven and cost-effective means of reducing levels of inappropriate antibiotic prescribing in primary care?

[Nicola Blackwood]

As my hon. Friend says, we must focus on innovation and better diagnostic tests, particularly bedside tests. The Government are actively reviewing evidence of the benefits of CRP tests. Pilot studies in the United Kingdom are contributing to that, and will be evaluated so that we can see how best to build on what can be shown to be working well.

[Jim Shannon (Strangford) (DUP)]

20. Given that 480,000 people develop multi-drug-resistant tuberculosis each year and that drug resistance is starting to complicate the fight against HIV and malaria, what steps has the Secretary of State taken to increase awareness in GP surgeries and to provide alternative treatments that can be equally effective, and what co-operation has taken place with devolved Assemblies?

[Nicola Blackwood]

I am grateful for that immediate promotion from the hon. Gentleman.

We have made considerable progress in establishing the building blocks of our domestic AMR strategy, including better data, guidance for primary care, and a strengthening of the framework for antimicrobial stewardship, which involves introducing incentives for the NHS to improve the prescribing of antibiotics. That has led, in the last quarter, to the first reduction in such prescribing, which I think we can take as an encouraging sign.

[Thangam Debbonaire (Bristol West) (Lab)]

One of the 10 recommendations of the O’Neill review on antimicrobial resistance was for a massive global public awareness campaign. Given that 700,000 people die each year as a result of AMR, and given the review’s estimate that that figure will rise to 10 million a year by 2050, what assurances can the Minister give that she is behind that awareness campaign?

[Nicola Blackwood]

The hon. Lady is right to identify the scale of the challenge, which is why we have put AMR on our national risk register, and she is also right to point out that no one country can tackle AMR alone. The United Kingdom has played a global leadership role. We co-sponsored the World Health Organisation’s 2015 global health plan and created the £265 million Fleming fund so that we could specifically help poor countries to tackle drug resistance, and we will continue to play that global leadership role.

[Daniel Zeichner (Cambridge) (Lab)]

The O’Neill report was published some six months ago and included recommendations for national Governments. What practical progress have the Government made so far?

[Nicola Blackwood]

On 19 September we published our comprehensive response to the report, which describes a range of actions that we will take on each of Lord O’Neill’s recommendations. The most practical progress that I can report is the fact that the prescribing of antibiotics has fallen for the first time since records began. I think that we can all be proud of that progress.

[Gavin Newlands (Paisley and Renfrewshire North) (SNP)]

4. What assessment he has made of the potential effect of the UK’s decision to leave the EU on the NHS workforce.

--- Later in debate ---

[Margaret Greenwood (Wirral West) (Lab)]

11. If the Government will make a recommendation to NHS England not to renew its primary care support contract with Capita.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

It is too early to speculate on the renewal of this contract, but it will ultimately be for NHS England to determine the selection criteria for the future procurement of services provided by it. My focus right now is on raising the quality of the existing contract, and I have been clear that the standard of Capita’s work under the contract has not been acceptable and it must improve. I continue to meet regularly with Capita and NHS England as they work to improve the performance of the service.

[Margaret Greenwood]

I thank the Minister for that response. Several GP practices in my constituency have reported serious delays in the transfer of medical records. In some cases the records have gone missing altogether, with serious implications for patient safety. I would like a clear response from the Minister about the assurances she can give to my constituents that the Government—not just NHS England, but the Government—take seriously the safe delivery of their confidential medical records.

[Nicola Blackwood]

I take this issue extremely seriously, which is why I am personally meeting NHS England and Capita fortnightly and ensuring that detailed rectification plans are in place for each service delivery programme. The improvements should happen between January and April next year. I shall be happy to write to the hon. Lady in more detail if she would like to be able to reassure her GPs, optometrists and dentists on those issues.

[Several hon. Members rose—]

[Kate Green (Stretford and Urmston) (Lab)]

Will the Minister advise GP practices in my constituency, who have been massively inconvenienced by the chaos of the Capita contract, that full compensation will be available for the inconvenience they have been put through?

[Nicola Blackwood]

At the moment, NHS England and Capita are focusing very hard on improving service delivery, which I think must be the top priority, but we are also looking into exactly what inconvenience and costs GPs have suffered, along with dentists and optometrists, and that will be considered and discussed with GPs.

[Rob Marris (Wolverhampton South West) (Lab)]

13. How many patient days of delayed discharge attributable to the levels of suitable social care available at the Royal Wolverhampton NHS Trust there were in (a) 2010 and (b) 2016.

--- Later in debate ---

[Natalie McGarry (Glasgow East) (Ind)]

15. What assessment he has made of the potential effectiveness of introducing (a) a ban on price-cutting promotions on unhealthy food in supermarkets and (b) restrictions on advertising of unhealthy food during family television programmes in reducing childhood obesity.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

In developing the childhood obesity plan, we considered the latest research and evidence on promotions and advertising, including Public Health England’s evidence package “Sugar reduction: the evidence for action”. We have made no secret of the fact that we considered a range of policies before finally settling on those set out in the childhood obesity plan. The plan includes the soft drinks industry levy and taking 20% of sugar out of certain products. We concluded that our plan is the right approach to secure the future health of our children.

[Natalie McGarry]

I associate myself with the Secretary of State’s words of sympathy for the people of Berlin, and I also add my thoughts for the people of Aleppo, Yemen, Gaza, Mosul and all the forgotten conflicts of the world.

Public health experts have dismissed the Government’s obesity strategy as a weak approach and a wasted opportunity. The Government say that they are committed to evidence-based policy making, but they have failed to acknowledge that relying on voluntary food action without tackling cost and availability is inherently flawed. Will the Minister commit the Government to getting a grip and bringing forward a ban or restrictions on advertising and price-cutting promotions on junk food?

[Nicola Blackwood]

I am happy to reassure the hon. Lady that current restrictions on advertising in the UK are already among the toughest in the world. For example, there is a total ban on the advertising of less healthy food during children’s television programmes. Those have been shown to be very effective. However, we also welcome action that has been taken by forward-thinking retailers on promotions elsewhere. In particular, Sainsbury’s has committed to removing multi-buy promotions across its full range of branded and own-brand soft drinks, confectionery, biscuits and crisps, removing more than 50% of its multi-buy promotions from its grocery business while lowering regular prices for products. It should be congratulated on leading the way.

[Mr Speaker]

We now feel considerably better informed.

[Mr Alan Mak (Havant) (Con)]

Advertising agencies and industry bodies can play a key role in ensuring that adverts are appropriate. Will the Minister continue working with the industry to tackle child obesity?

[Nicola Blackwood]

Yes.

[Margaret Ferrier (Rutherglen and Hamilton West) (SNP)]

Certain supermarkets persist in placing less healthy foods on promotion near the entrances to their stores, where they are unavoidable. Does the Minister agree that it is not just at checkouts that healthy options should be promoted, and that retailers should exercise more responsibility?

[Nicola Blackwood]

I absolutely agree that putting healthier options near checkouts and helping people to make healthier choices are part of retailers’ responsibilities. What has been notable in my discussions with retailers is that the penny is starting to drop that this is the direction of travel and what the public want, and I think we are going to start seeing a real sea change in the way retailers are advertising.

[Several hon. Members rose—]

[Philip Davies (Shipley) (Con)]

May I urge the Minister not to go down this ridiculous nanny-state route—which one would not expect from a Conservative Government—of setting up an unhealthy food police to go round telling people what they should be eating and what they should not be eating? No food eaten as part of a balanced diet is in itself particularly unhealthy. If the Government are so concerned about families that are just about managing, why on earth would they even contemplate increasing costs for working families?

[Nicola Blackwood]

My hon. Friend flatters me by saying he thinks I am a nanny—it is really quite a disturbing thought. However, what we have here is an obesity plan that balances the need to cut the sugar in young people’s diets, as a way to make sure they get a healthy diet, and individual choice, which we know is absolutely a Conservative ideal.

[Chris Green (Bolton West) (Con)]

T2. If he will make a statement on his departmental responsibilities.

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[Fiona Bruce (Congleton) (Con)]

T8. Has the public health Minister had an opportunity to consider the recent report sent to her by the all-party parliamentary group on alcohol harm on the shocking impact of excessive drinking by members of the public on the dedicated people who work in our emergency services? Will she meet the APPG to discuss this?

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I pay tribute to my hon. Friend for her dogged campaigning on this issue, on which she is a true champion. I have not had a chance to read the report in detail, but I have seen a number of its recommendations and we are taking action on some of them, including the publication of the chief medical officer’s low risk guidelines and Public Health England’s One You campaign, which runs over Christmas and the new year. We are embedding alcohol measures into the NHS health check and we have introduced a national CQUIN—Commissioning for Quality and Innovation—because evidence shows that intervention by a health professional is the most effective way of disrupting problem drinking.

[John Mann (Bassetlaw) (Lab)]

T4. Zac from Worksop is three years old, wheelchair-bound, unable to speak and blind, and is regularly admitted on an unplanned basis to Bassetlaw Hospital’s children’s ward. As the people of Bassetlaw are standing with Zac in opposing the proposed overnight closure of the children’s ward, which will create chaos for his small life and that of a number of other very poorly children like him, will democracy prevail, or are the Government going to pick a fight with Zac, me, and the people of Bassetlaw?

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[Adam Afriyie (Windsor) (Con)]

Despite some of the obvious challenges in the healthcare service, this is a wonderful time of year when hundreds of thousands of people choose to quit smoking by putting down their cancer stick and picking up an electronic vaping device. Does the Minister share my concern, however, that we must be very cautious in any implementation of the EU tobacco products directive so that it does not act as a barrier to people quitting smoking and taking up vaping?

[Nicola Blackwood]

The Government are very clear that vaping is significantly less harmful than continuing to smoke. Under the current regulatory regime, huge numbers of smokers are successfully using these innovative products as an effective quitting tool. We have already committed to reviewing the TPD and we will fully explore the opportunities that Brexit may provide, but until exit negotiations are concluded we remain a full member of the EU.

[Mr David Hanson (Delyn) (Lab)]

T5. On contaminated blood, will the Government confirm that they still plan to use a private profit-making company such as Atos to administer the scheme, and if so, why?

[Nicola Blackwood]

I absolutely cannot confirm that. The tendering process has not even begun. Therefore, we are not considering any form of company, private or otherwise.

[Dr Sarah Wollaston (Totnes) (Con)]

The Health Committee has just published its interim report on preventing suicide. I thank all those who gave evidence to our inquiry and all members of the Department of Health advisory group. We support the strategy, but the clear message that we heard was that implementation needs to be strengthened. Will the Secretary of State meet me to discuss our report’s recommendations, and will he join me in thanking members of the Samaritans and other voluntary groups around the country who will be working tirelessly over Christmas, as they do every day, to support those in crisis?

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[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

TB rates are currently higher in bits of Ealing than in Rwanda. Could the Government better the bilateral innovation fund to which they have committed with China and go for the O’Neill report recommendation to work towards a truly global fund, in conjunction with other nations, to fight antimicrobial resistance?

[Nicola Blackwood]

As I have already answered, we are a world leader on AMR. We have not only the bilateral fund with China but the £265 million Fleming fund, through which we will deliver bilateral national action plans with a number of developing nations. We are committed to going further than that through the global action plan with the UN.

[Tom Pursglove (Corby) (Con)]

A fortnight ago, I visited the pharmacy at the Corby urgent care centre to thank the dedicated staff for all that they do all year round, and to have a flu jab as part of the ongoing campaign. Does the Minister agree that exactly that sort of proactive working is crucial in trying to tackle winter pressures?